| NPI | 1609613322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LENA NIKOLNIKOV Mgr 410-977-3009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2024-07-10 |
| Last Update Date | 2024-07-10 |